Opioids and Other Psychoactive Substances

Primary reference(s)

NIDA 2020 July 6 Drug Misuse and Addiction. Accessed 20 January 2025.

Annotations

Key relevant UN convention / multilateral treaty

Several key United Nations conventions and multilateral treaties address issues related to the control of addictive substances such as opioids, alcohol, and nicotine. Here's an overview:

Opioids:

Single Convention on Narcotic Drugs (1961, as amended in 1972): Establishes international control over narcotic drugs, including opioids, to limit their use to medical and scientific purposes while preventing illicit production and trafficking. Administered by the International Narcotics Control Board (INCB).

Convention on Psychotropic Substances (1971): Aims to control psychotropic substances, including certain synthetic opioids, to prevent misuse while ensuring their availability for legitimate purposes.

United Nations Convention against Illicit Traffic in Narcotic Drugs and

Alcohol: No specific global treaty regulates alcohol in the same way as narcotics, but alcohol is indirectly addressed under health and public policy frameworks:

Global Strategy to Reduce the Harmful Use of Alcohol (2010): A non-binding framework by the World Health Organization (WHO) encouraging member states to implement policies addressing alcohol misuse.

WHO Framework Convention on Tobacco Control (2003): Although focused on tobacco, this treaty includes measures related to the dual-use of substances like alcohol and tobacco, recognizing the intersection of public health challenges.

Nicotine (Tobacco): WHO Framework Convention on Tobacco Control (FCTC, 2003): The first legally binding health treaty under WHO, focusing on reducing tobacco consumption and exposure to nicotine products. Includes measures on advertising bans, tax policies, and restrictions on public smoking.

Drivers

Hazard Drivers for Opioid Dependence: There are a number of risk factors for opioid overdose as described by WHO (WHO, 2023). These include: 

• having an opioid use disorder;
• taking opioids by injection;
• resumption of opioid use after an extended period of abstinence (e.g. following detoxification, release from incarceration, cessation of treatment);
• using prescription opioids without medical supervision;
• high prescribed dosage of opioids (more than 100 mg of morphine or equivalent daily).
• using opioids in combination with alcohol and/or other substances or medicines that suppress respiratory function such as benzodiazepines, barbiturates, anaesthetics or some pain medications; and
• having concurrent medical conditions such as HIV, liver or lung diseases or mental health conditions. 

Males, people of older age and people with low socio-economic status are at higher risk of opioid overdose than women, people of young age groups and people with higher socio-economic status. 

Hazard Drivers for Alcohol Dependence (Mustafa 2024): 

A. Biological and Genetic Factors 

1. Family History of Addiction: Having a parent or close relative with alcohol addiction increases the risk due to genetic predisposition.
2. Neurochemical Imbalances: Altered levels of neurotransmitters, such as dopamine, can make individuals more susceptible to addiction.
3. Early Onset of Drinking: Initiating alcohol consumption at a young age is linked to higher risk of developing dependence. 

B. Psychological Factors 

1. Mental Health Disorders: Conditions like depression, anxiety, or PTSD often coexist with alcohol misuse.
2. Stress and Coping Mechanisms: Using alcohol as a coping mechanism for stress increases the risk of dependency. 

C. Social and Environmental Factors 

1. Peer Pressure: Strong influence from peers can lead to habitual alcohol use.
2. Cultural Norms: Societal attitudes that normalize or glamorize drinking can increase risk.
3. Availability and Accessibility: Easy access to alcohol significantly raises the likelihood of abuse. 

D. Other Factors 

1. Trauma and Adverse Childhood Experiences (ACEs): Early-life trauma is strongly associated with addiction risks.
2. Lack of Education: Poor understanding of the risks associated with excessive alcohol consumption can contribute. 

Hazard Drivers for nicotine dependence (Benowitz 2010): 

A. Biological and Genetic Factors 

1. Genetic Susceptibility: Genetic variations can affect how the body processes nicotine and the likelihood of addiction.
2. Adolescent Brain Development: Young brains are particularly sensitive to the effects of nicotine, increasing addiction risks. 

B. Psychological Factors 

1. Coexisting Mental Health Conditions: Anxiety and depressive disorders are common among individuals with nicotine dependence.
2. Impulsivity and Sensation-Seeking: Personality traits that favour risky behaviours are linked to higher nicotine use. 

C. Social and Environmental Factors 

1. Peer and Social Influence: Adolescents are particularly vulnerable to smoking due to peer pressure.
2. Marketing and Advertising: Targeted advertisements and media representations glamorizing smoking contribute significantly.
3. Family Smoking Habits: Exposure to smoking within the household normalizes the behaviour and increases risk 

Impacts

Opioids are the deadliest drug type. According to the US Drug Enforcement Administration (DEA) seven out of ten illegal fake pills in the streets with fentanyl contain a potentially lethal dose (at least 2 mg of fentanyl). Drug traffickers are using fake pills to exploit the opioid crisis and prescription drug misuse. In 2022, an estimated 110,757 people died by drug poisoning in the United States. Fentanyl, the synthetic opioid most found in fake pills, is the primary driver in this alarming increase in poisoning deaths. According to WHO estimates, approximately 125,000 people died of opioid overdose in 2019.

Multi-hazard context

The figure below summarises common interactions between opioids & other addictive substances and other hazards. This information should be used with caution and not be solely relied upon in Disaster Risk Management, particularly as some interactions may not have been included. Note that hazardous events occurring together or locally in space or time may not necessarily cause, amplify or be otherwise related to each other. Specific examples of multi-hazard context can be found in the ‘Hazard drivers’ and ‘Impacts’ sections above.

Multi-hazard diagram

Risk Management

Detection of fentanyl is difficult since it has no taste, no smell, and cannot be distinguished by touch. Some recent detection efforts include fentanyl test strips (FTS) and advanced handheld Raman spectrometers analysers such as Tactic ID or TruNarc™, which are narcotic analysers. Portable mass spectrometers may also prove useful. FTS are small strips of paper that can detect the presence of fentanyl in different kinds of drugs and drug forms and can inform people about the presence of fentanyl so they can take steps to reduce their risk of overdose. There is also a commercial strip version that combines both fentanyl and xylazine in one test strip. The Raman spectrometers allow the first responders to quickly and accurately identify key drugs of abuse anywhere at any time without opening the containers (Crocombe 2023).   

Uncontrolled opioid use can lead to dependence, both physical and mental. There are observable withdrawal symptoms and a sustained mental need for the drug or substance. An overdose needs immediate attention due to its fatal consequences. The best is the use of an antidote, now more commonly used is naloxone, which is an antagonist of the opioid receptors and reverses the overdose (van Dorp, 2007). Naloxone comes in different forms, but the most common is the nasal spray with similar action times as an intramuscular injection. Sometimes several doses of are needed to reverse a strong opioid overdose. WHO recommends that naloxone be made available to people likely to witness an opioid overdose, as well as training in the management of opioid overdose. More recently, in the US, a similar delivery method has been manufactured with nalmefene with the advantage of having a longer half-life (11.4 hrs) vs. 1.2 hrs than naloxone (Green 2024).

WHO recommends the use of a range of treatment options for opioid dependence. These include opioid agonist maintenance treatment (with medicines such as methadone and buprenorphine), which has the strongest evidence of effectiveness and cost-effectiveness, as well as psychosocial treatment and support, and pharmacological treatment with opioid antagonists (such as naltrexone). 

Monitoring

No Information Available